Adult

Healthcare-associated pneumonia (HAP) including aspiration pneumonia: severe

If sepsis is suspected see Systemic sepsis of UNKNOWN source

If patient develops signs and symptoms within 48 hours of hospital admission: See Community acquired pneumonia guidelines

  • Healthcare: Hospital, community hospital, nursing home.
  • For more complex cases where escalation of treatment is considered, please discuss with Micro/ID.
  • Patients who have tracheostomy or are intubated can have respiratory sampling performed.
  • Legionella antigen testing on urine can be considered.
  • Modify treatment according to sensitivity test results.
  • Antibiotics should be given within 4 hours.

Treat for 3-5 days (review iv daily)

Review empirical treatment within 48 hours 

Preferred

Amoxicillin 1g iv tds AND gentamicin 5mg/kg iv (Gentamicin is for a maximum of 3 days). Take a gentamicin level at 6-14 hours after first dose to calculate dosing interval, usually 24 hourly, 36 hourly or 48 hourly. See gentamicin monograph for dosing (including renal dosing) and monitoring. 
For IV to oral switch, see HAP non-severe or Consult Micro/ID if further IV needed after 3 days.

Alternative

For patients with penicillin allergy label consider penicillin allergy assessment and delabelling.

For (non-severe/severe) penicillin allergy or MRSA positive:
co-trimoxazole 960mg po or iv bd
OR 
teicoplanin 12mg/kg iv (see teicoplanin monograph for dose banding, dose frequency and monitoring) AND gentamicin** 5mg/kg iv (Gentamicin is for a maximum of 3 days).

**Take a gentamicin level at 6-14 hours after first dose to calculate dosing interval, usually 24 hourly, 36 hourly or 48 hourly. See gentamicin monograph for dosing (including renal dosing) and monitoring. See monographs for dose banding, dose frequency and monitoring.  

Additional information

  • Seek specialist advice from a microbiologist for people with hospital-acquired pneumonia if they have:
    • symptoms that are not improving as expected with antibiotics or
    • multidrug-resistant bacteria
  • Explain to patient that after starting treatment their symptoms should steadily improve, although the rate of improvement will vary with the severity of the pneumonia. Most adults can expect that by:
    • 1 week: fever should have resolved
    • 4 weeks: chest pain and sputum production should have substantially reduced
    • 6 weeks: cough and breathlessness should have substantially reduced 
    • 3 months: most symptoms should have resolved but fatigue may still be present 
    • 6 months: they will feel back to normal

Editorial Information

Last reviewed: 13 Feb 2026

Next review date: 10 Feb 2029

Author(s): AMST.

Approved By: ASG